Lip Repair Research Articles

Case report: Two cases of Cleft rhinoplasty

The correction of cleft lip nose deformity remains a great challenge for any cleft surgeon. The nose is a prominent part of the face, and any cleft lip repair directs the beholders’ eyes from the deformed lip to the deformed nose, Controversies exist on the timing of rhinoplasty in cleft lip patients and is categorized as primary rhinoplasty performed at the time of cleft lip repair, intermediate rhinoplasty at the age of 5–11 years and definitive rhinoplasty. This article presents two cases of unilateral nasal cleft in two adults treated by secondary rhinoplasty using an open technique. The primary deformity is an imbalance between abnormal muscle insertion and maxillary skeletal hypoplasia. The general characteristics of this deformity are a very short columella, downward rotation of the tip and diminished nasal projection, and treatment of this depressed and hypoplastic bony scaffolding is the secret to successful secondary rhinoplasty. Proponents of delayed nasal repair suggest that altering the cartilages in early nasal repair at the time of lip repair would complicate future corrective nasal surgeries if the primary repair would prove unsatisfactory. However, we know that repositioning the wing cartilage at the same time as closing the lip respects nasal growth by using a rigorous technique and control of scars The aim of cleft lip rhinoplasty is both aesthetic and functional: to obtain a normal nose with nasal breathing.

Effectiveness of 2 Lip Taping Techniques in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial.

This trial was designed to test the efficacy of 2 lip taping methods in modifying the maxillary arch dimensions (MADs) of infants with bilateral cleft lip and palate (BCLP) before lip repair surgery. Parallel-group randomized clinical trial. The trial was conducted at 3 centers in Baghdad city. Thirty-six nonsyndromic infants with BCLP. The eligible infants were randomly assigned to either the first experimental group that received a conventional horizontal tape (3 M Steri strip-1/4 inch) or the second experimental group that received a custom-made tape made of Steri strips and orthodontic extra oral elastics. All of the included infants in both groups had rubber base impressions taken for them at the start of treatment (T1) and right before surgical lip repair (T2). A desktop scanner was used to scan each of the generated models, creating digital models that could be used for outcome evaluation. Virtual MAD measurements were performed by a blinded assessor on the generated digital models both before (T1) and after (T2) treatment. At T2, both groups showed statistically significant changes in all measured MADs, with a mean difference ranging from 1.36 to 2.95 mm for the conventional taping group and from 1.46 to 7.96 mm for the custom-made one. The comparison of the 2 groups revealed both statistically and clinically significant differences with a P value <.05. The custom-made taping demonstrated more constriction in maxillary arch in terms of changes, which could provide easier surgical manipulation for the cleft parts. Lip taping appears to be an efficient technique for modifying the MADs in infants with BCLP.

Surgical Correction of Secondary Bilateral Cleft lip and Nasal Deformities Using the Delaire-Precious Technique.

This study aimed to determine the efficacy of the surgical correction of secondary bilateral cleft lip and nasal deformities using the Delaire-Precious technique for Asian patients with bilateral cleft lip +/- palate (BCL+/-P). Retrospective cohort study. Thirty-six patients with BCL+/-P in Japan, the Philippines, and Vietnam underwent secondary lip correction using the Delaire-Precious technique by a single surgeon. The critical concepts of this surgical technique are discussed and clarified. A patient/parent satisfaction survey was carried out to evaluate the usefulness of this technique. The Delaire-Precious technique improves Cupid's bow's symmetry and the central tubercule's volume. The scar tissue between lateral and medial philtrum incisions is excised. The orbicularis oris muscle is then reconstructed with a midline suture placed above the periosteum of the premaxilla. Most patients (90.9%) and all parents were at satisfied with the surgical result. The technique was highly satisfactory to patients and parents except at the level of scar correction. The secondary bilateral cleft lip and nasal repair using the Delaire-Precious technique is an adaptable technique that can be applied to various ethnic groups. It was found to be a satisfactory technique for Asian patients with BCL+/-P.

Long-Term Nose Evaluation After Treatment of Bilateral Cleft Lip Using the Spina Technique.

Bilateral cleft lip (BCL) repair is a challenge due to anatomic and functional distortions, worse than unilateral cleft. With regard to the nose, BCL can result in certain characteristics, such as a short columella, a flattened and widened tip, and horizontally oriented nostrils. Lip and nose treatment is advocated by some surgeons to achieve a better outcome. One of the techniques used to treat this condition is the one recommended by Victor Spina, in a complex protocol involving more than one surgical procedure and long-term follow-up. The aim of this study is to evaluate the growth of the nose in patients treated using the Spina technique. This was a retrospective and analytical study of the medical records of patients who were treated using the Spina technique at the Assistance Center for Cleft Lip and Palate (CAIF) at Hospital do Trabalhador in Curitiba, Brazil. Anthropometric measurements of interalar distance and nose tip projection were made from frontal and submental photographs taken at three moments: pre-first surgery, pre-definitive surgery, and late follow-up. Furthermore, other analyzed parameters were: sex, date of birth, age at time of surgery, and late follow-up. With these data, a comparison of nose growth was made between patients with BCL and a population without craniofacial anomalies observed in a study by FARKAS et al (1992). The comparison also took sex and age variables into account. Regarding the interalar distance measurements, both sexes showed a widening of the nose before starting treatment. This widening was maintained throughout follow-up. The growth curve, in turn, remained similar among males, with an average growth rate of only 3.2% higher in patients with BCL. Among females, the difference was one of 16.92%. In terms of nasal tip projection, there was an average increase of 1.12cm (86.15%) in males and 0.69cm (57.02%) in females. It was possible to notice a nasal growth rate in those with BCL similar to the normal pattern and a significant improvement in nasal tip projection in male patients. However, with regard to the data of both sexes, but especially females, the low number of patients jeopardized the significance of the results.

Use of De-Epithalialized Flap for Elevating the Alar Base in Patients With Cleft Lip.

Alar base asymmetry is a common problem in cleft lip patients. Caused by a lack of bone support and soft tissue deficiency, it is one of the problems that must be corrected during cleft lip repair. While it is encountered during primary lip repair, it can also be seen as a secondary cleft lip nasal deformity after repair. This study aimed to provide alar base symmetry with a de-epithelialized muscle-skin flap during the primary cleft lip repair of incomplete cleft lip patients and secondary cleft lip deformity repair. In incomplete cleft lip patients, the tissue under the incomplete part is de-epithelialized and elevated as a superiorly based flap. The flap is rotated and sutured under the alar base for the elevation. In secondary patients, scar tissue to be removed is de-epithelialized and elevated as a superiorly based flap. It is turned over and sutured under the alar base for augmentation. The effect of the surgery is monitored during the follow-up period. There were no complications related to the flap, and no volume loss was observed. Using a de-epithelialized musculocutaneous flap, the augmentation of the alar base and nasal sill can be achieved without additional incisions in patients undergoing primary incomplete cleft lip repair and in patients undergoing secondary cleft lip deformity repair. We think it is an effective and safe method, improving the esthetic outcomes of cleft lip patients.

Speech Outcome Audit for Cleft Lip and Palate Patient Population Correlated With Veau Cleft Type, Surgical Repair Technique, and Patient Age

Objective: The objective of this study is to determine speech outcome differences for specific palate repair techniques and correlate these data with patient age at the time of operation. Methods: A retrospective study was conducted on a cohort of consecutive nonsyndromic patients who underwent cleft lip and/or palate repair at the authors' hospital between 2010 and 2020. Only those patients who participated in at least 4 years of follow-up accompanied by audio-video recording were included. The patient cohort was divided into 2 age groups, between 1 year and 2 years of age versus older than 2 years of age. Standardized perceptual speech evaluations and nasopharyngoscopy were performed by the authors' team to detect the presence of velopharyngeal insufficiency. Results: A total of 481 patients were initially evaluated, and 323 of these patients met all inclusion criteria and were subsequently selected for this study. One hundred seventy-two patients (n = 172) underwent palatal surgery using the Bardach 2-flap palatoplasty technique, 47 patients (n = 47) underwent repair through the von Langenbeck palatoplasty technique, 78 patients (n = 78) underwent repair through Veau-Wardill-Killner palatoplasty technique, and 26 patients (n = 26) underwent repair through double-opposing Z-plasty palatoplasty. The rate of residual velopharyngeal insufficiency was statistically similar among all palatoplasty techniques. A comparison between these two age groups revealed that patients younger than 2 years of age showed higher speech outcome success. Conclusion: High rates of speech success are achieved for patients younger than 2 years of age. Speech outcomes success is maximized by proper technique selection in relation to cleft type.

Nasal Light Reflex: A Useful Intraoperative Tool in Correction of Cleft Lip Nasal Deformity.

The correction of a unilateral cleft lip nasal deformity remains a challenge to cleft surgeons. It is difficult to obtain a routinely predictable outcome. This is in part due to there being no objective intraoperative method to assess the correction. We have come up with a simple objective intraoperative method to plan and assess the correction of the nasal deformity. This is done by assessing the nasal light reflex using a mobile phone camera to define the deformity. The points of the desired correction of the lower lateral cartilage are transposed onto the patient. Once the lip and nose repair is completed, another photograph is taken to assess the nasal light reflex and assess the extent of correction. If this is inadequate, further nasal correction is performed. We have used this procedure in 122 cleft lip patients with 93 complete and 29 incomplete. We have found this to be a useful objective intraoperative method to assist in obtaining improved nasal correction in cleft lip patients. As is well known, relapse of the nose is common in cleft lip repairs, but this method allows one to better gauge the correction at the primary surgery. Nasal light reflex should be added to the armamentarium of cleft surgeons to assist in superior correction of the nose, which is an item that continues to vex these surgeons.

Tensile force impairs lip muscle regeneration under the regulation of interleukin-10.

Orbicularis oris muscle, the crucial muscle in speaking, facial expression and aesthetics, is considered the driving force for optimal lip repair. Impaired muscle regeneration remains the main culprit for unsatisfactory surgical outcomes. However, there is a lack of study on how different surgical manipulations affect lip muscle regeneration, limiting efforts to seek effective interventions. In this study, we established a rat lip surgery model where the orbicularis oris muscle was injured by manipulations including dissection, transection and stretch. The effect of each technique on muscle regeneration was examined by histological analysis of myogenesis and fibrogenesis. The impact of tensile force was further investigated by the in vitro application of mechanical strain on cultured myoblasts. Transcriptome profiling of muscle satellite cells from different surgical groups was performed to figure out the key factors mediating muscle fibrosis, followed by therapeutic intervention to improve muscle regeneration after lip surgeries. Evaluation of lip muscle regeneration till 56days after injury revealed that the stretch group resulted in the most severe muscle fibrosis (n=6, fibrotic area 48.9% in the stretch group, P<0.001, and 25.1% in the dissection group, P<0.001). There was the lowest number of Pax7-positive nuclei at Days 3 and 7 in the stretch group (n=6, P<0.001, P<0.001), indicating impaired satellite cell expansion. Myogenesis was impaired in both the transection and stretch groups, as evidenced by the delayed peak of centrally nucleated myofibers and embryonic MyHC. Meanwhile, the stretch group had the highest percentage of Pdgfra+ fibro-adipogenic progenitors infiltrated area at Days 3, 7 and 14 (n=6, P=0.003, P=0.006, P=0.037). Cultured rat lip muscle myoblasts exhibited impaired myotube formation and fusion capacity when exposed to a high magnitude (ε=2688μ strain) of mechanical strain (n=3, P=0.014, P=0.023). RNA-seq analysis of satellite cells isolated from different surgical groups demonstrated that interleukin-10 was the key regulator in muscle fibrosis. Administration of recombinant human Wnt7a, which can inhibit the expression of interleukin-10 in cultured satellite cells (n=3, P=0.041), exerted an ameliorating effect on orbicularis oris muscle fibrosis after stretching injury in surgical lip repair. Tensile force proved to be the most detrimental manoeuvre for post-operative lip muscle regeneration, despite its critical role in correcting lip and nose deformities. Adjunctive biotherapies to regulate the interleukin-10-mediated inflammatory process could facilitate lip muscle regeneration under conditions of high surgical tensile force.

Three-dimensional Analysis of Presurgical Nasoalveolar Molding Outcomes in Patients with Unilateral Cleft Lip and Palate: A Preliminary Study Using LED Surface Scanning Technology.

ObjectivesPresurgical infant orthopedic appliances, such as presurgical nasoalveolar molding (PNAM) devices, are used to attain optimal conditions for primary repair of the lip and nose (PRoLN) in patients with cleft lip. We aimed to analyze the three-dimensional (3D) outcomes of PNAM using an LED surface scanner. MethodsFifteen patients with unilateral cleft lip and palate (CLP) were included in this study and treated using a PNAM device. The patients’ faces were digitized pre- and post-PNAM using an Artec Space Spider scanner, and the scanned data were analyzed using 3D software (Geomagic Control X and ANSYS SpaceClaim). The columellar angle (CA), nostril curvature (NC) on the affected (NC_A) and unaffected (NC_U) sides, gap of cleft lip (GCL), alar width (AW), and nasal tip angle (NTA) were measured. ResultsCA increased significantly by 10.00° and NC_A by 0.030 mm-1 (p<0.001). GCL decreased by 4.98 mm2 on average and NC_U by 0.015 mm-1 (p=0.029 and 0.046, respectively). AW also decreased by approximately 1.22 mm pre- and post-treatment (p=0.002), and NTA, which shows a lateral profile, decreased by approximately 3.32° (p=0.002). ConclusionsThis study confirmed the orthopedic benefits of PNAMd treatment through 3D analysis using an LED surface scanner. Further studies involving a larger number of participants are warranted to study the effects of PNAM and analyze longitudinal changes in patients with CLP. Clinical SignificanceThis study shows that PNAM effectively corrects columellar deviation and nostril shape in patients with unilateral cleft lip, with 3D scanners enhancing primary lip and nose repair outcomes.

Specialists Versus Trainees: Long-Term Secondary Deformity After Unilateral Cleft Lip Repair

Specialists Versus Trainees: Long-Term Secondary Deformity After Unilateral Cleft Lip Repair

Comparison of palatal fistula incidence post palatoplasty with Veau-wardill kilner technique between men and women

Cleft palate is a congenital abnormality that occurs in the mouth and surrounding structures. The most used classification of cleft palate by Veau (1931). To repair the palatal defect, shape and function, surgical correction is necessary. There are various types of palatoplasty techniques that can be used, such as Veau-Wardill-Kilner. Palatoplasty may causes complications such as palatal fistula. Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Airlangga University has been carrying out a social service for cleft lip and palate surgery repair since year 2008 in various regions in Indonesia. However, until now, there is no data available related with the incidence of palatal fistula. Purpose: To observe the comparison between the palatal fistula incidence post palatoplasty using Veau-Wardill-Kilner technique based on gender. Methods: This study based on 113 palatoplasty cases using Veau-Wardill-Kilner technique taken from Oral and Maxillofacial Cleft Palate Surgery Social Service data, Faculty of Dental Medicine, Airlangga University from the period of 2013 until 2022. Data analysis used Kruskal-Wallis on IBM SPSS version 29 Windows. Results: from 113 patients, 20 cases (17,7%) showed that there is developed palatal fistula. Between the incidence of palatal fistula in men and women observed after palatoplasty procedure using Veau-Wardill-Kilner, higher percentages of palatal fistula were found in women (p=0.426). Conclusion: The incidence of palatal fistula post palatoplasty using Veau-Wardill-Kilner technique in women is higher than men.

Anaphylactic reaction to tranexamic acid infusion in a six-year-old child: a case report

BackgroundTranexamic acid (TXA) is commonly considered a safe drug to mitigate bleeding during and after various surgical settings among adults and children. In recent decades, anaphylaxis induced by TXA has been increasingly reported in adults. However, among pediatrics, there are fewer reported cases.Case presentationWe report a case of a 6-year-old female who experienced anaphylaxis after receiving intravenous TXA following unilateral cleft lip and palate repair surgery. She exhibited clinical symptoms involving the cardiovascular system, respiratory system, and skin. Following the administration of epinephrine, corticosteroid, and anti-histamine, the patient’s symptoms were relieved. A few months after discharge, an intradermal test, yielded a positive result, confirming TXA as the culprit drug.ConclusionOur report emphasizes the importance of considering anaphylaxis as a potential adverse reaction to TXA in pediatric patients, showing the criticality of rapid diagnosis and appropriate management for a successful outcome.

Three-dimensional Assessment of Longitudinal Surgical Outcome in Patients with Unilateral Cleft Lip and Palate: A Modified Rotation Advancement Technique.

Optimization of a modified rotation advancement technique is hampered by lack of objective measures to quantify the longitudinal surgical outcome. We collected and assessed facial 3D images of 115 consecutive patients who underwent primary repair between 2017 and 2019. Photogrammetry was performed preoperatively, immediately postoperatively and at a first and second follow-up interval, occurring at an average year of 0.6 and 5.3 years, respectively. 10 additional age-matched noncleft control subjects were also included. Growth lag in cleft side lateral lip and gradual elongation of medial lip height on the cleft side caused continuous deviation of philtrum towards the cleft side. The columellar length on the cleft side continued to grow slower, accompanied by a persistent widening of alar base width on the cleft side, leading to in the gradual deviation of columella towards the cleft side. The pre-operative and post-operative nasolabial asymmetry would increase with greater degree of postoperative deficiencies. Right clefts presented with greater degrees of deficiencies in lateral lip height in preoperative measurement, but this discrepancy of the laterality of clefts was not observed in the two follow-up periods. The surgical outcome of this modified rotational advancement technique in unilateral cleft lip primary repair is promising. Growth lag in lateral lip and lateral displacement of alar base cause continuous deviation of philtrum towards the cleft side. Pre-operative severity does predict post-operative outcomes. Laterality of oral clefts does not significantly affect the long-term outcomes of surgery. This surgical technique meets the current trend of cleft lip and palate primary repair and is worth promoting.

Is Postoperative Nasal Stenting Necessary After Primary Cleft Lip and Nose Repair?

Is Postoperative Nasal Stenting Necessary After Primary Cleft Lip and Nose Repair?

A 37-year follow-up after Skoog lip repair of unilateral cleft lip and palate: what is the long-term verdict on lip appearance by different panels?

BackgroundThe study examined long-term lip appearance after Skoog’s lip repair in unilateral cleft, lip, and palate (UCLP) patients. To include different views, three different panels respectively, rated level of lip appearance and desire for improvement. The secondary aim was to investigate the correlation between the self-reported satisfaction of UCLP patients and controls with the panel assessments.MethodsCropped frontal photographs of the lips of 74 UCLP-treated individuals and 61 non-cleft individuals were assessed twice by three panels of five cleft surgeons (Professional panel), nine laymen (Layman panel), and five individuals with CLP (Cleft panel) using a web-based platform, at a mean follow-up of 37 years post-lip surgery.ResultsAll three panels rated the lip appearance of UCLP patients worse than that of the controls (p < 0.001). The Professional panel reported higher satisfaction levels and less desire to change lip appearance than the Layman and Cleft panels. Intra-rater agreements were, in general, moderate in the Professional panel ICC (0.57–0.82) and Laymen panel ICC (0.63–0.73) and poor in the Cleft panel ICC (0.21–0.36). The inter-rater agreement was, in general, poor in all panels. No significant correlation was found between the patient’s Self-assessments and any of the panel assessments.ConclusionsAll panels’ rated lip appearance of adults born with UCLP treated with Skoog’s technique as worse than that of non-cleft controls. The study highlights a significant discrepancy between the Professional panel’s more favorable assessment and the more critical views of the laymen and cleft panels, contradicting the initial hypothesis of uniform perception across panels. The lack of correlation between patient self-assessment and panel assessments underscores the subjective nature of lip satisfaction, emphasizing the need for personalized patient care strategies in CLP treatment outcomes.Level of evidenceNot gradable.

Lip Symmetry After Cleft Lip Repair Fisher in Unilateral Cleft Lip: A Systematic Review

The purpose of this research is to learn the outcomes of lip symmetry after cleft lip repair by Fisher in unilateral cleft lip compared with other techniques. This systematic review searched English full-text available articles in 4 databases: Cochrane, PubMed, ScienceDirect, and Google Scholar, and hand searched through grey literature and reference lists. Subjects were those with unilateral cleft lip without syndromic disorders who had primary cleft lip repair. The authors compared the technique by Fisher with other cleft lip repair techniques. Outcomes were lip symmetry determined quantitatively by lip anthropometric measurement and qualitatively by the Steffensen grading criteria. Four studies were included with a total of 150 cleft lip repairs, comparing the technique by Fisher with techniques by Millard, Mohler, and modified Millard. The 4 studies underwent critical appraisal, data analysis, qualitative synthesis, and meta-analysis. Assessment with Cochrane Risk of Bias 2 for randomized controlled trials and “Risk of Bias in Nonrandomized Studies–of Interventions” for nonrandomized studies displayed an overall high risk of bias in the included studies. “Grading of recommendations, assessment, development, and evaluation” revealed a very low quality of evidence for this review. All 4 studies noted better subjective lip symmetry in the technique by Fisher, but lip and vermilion height were better after the technique by Millard. This review found superior lip symmetry quality but inferior lip symmetry anthropometry after the technique by Fisher compared with the technique by Millard and its modifications, with a low quality of evidence.

Long-Term Surgical Outcomes of Primary Rhinoplasty.

To examine the impact of primary rhinoplasty on subsequent rhinoplasties for patients with cleft lip nasal deformity. Retrospective cohort study. Tertiary care pediatric hospital. Individuals who underwent definitive cleft lip repair at our institution from 2000 to 2006 with a current age of 18 or older. Number and timing of subsequent rhinoplasties. Among 199 individuals, 94 (47.2%) underwent primary rhinoplasty. Follow-up was 15.0 ± 4.8 years in the PR cohort and 15.0 ± 5.1 years in the NPR cohort (p = 0.993). In bilateral cleft lip, interdomal suture predicted fewer subsequent rhinoplasties (β=-0.310, p = 0.033), while history of primary rhinoplasty predicted greater age at subsequent rhinoplasty (β=1.800, p = 0.040). Among individuals with follow-up beyond age 18, intranasal stenting predicted fewer subsequent rhinoplasties (β=-0.609, p = 0.015). Most underwent subsequent nasal correction aside from 7 (19.4%) and 9 (20.9%) in the PR and NPR cohorts, respectively (p = 0.536). There was no difference in mean subsequent rhinoplasties between cohorts (1.1 ± 0.8 versus 1.3 ± 1.1, p = 0.284). Individuals with complete cleft lip underwent more lifetime rhinoplasties (1.9 ± 1.0 versus 1.2 ± 1.2, p = 0.007). Primary rhinoplasty with interdomal tip sutures in bilateral cleft lip was associated with fewer subsequent rhinoplasties. Primary rhinoplasty may delay subsequent nasal correction, though most who underwent primary rhinoplasty ultimately required nasal correction later in childhood. Postoperative nasal stenting may provide longer-term nasal benefits and should be considered at time of definitive cleft lip repair.

Anatomic Subunit Cleft Lip Repair: New Repair Concept Based on Nostril Sill and Philtrum-White Roll Junction.

A novel method for unilateral cleft lip repair based on lip anatomic subunits was presented in 2005 by David M. Fisher. It has about 25 landmarks with 2 arbitrary markings for the nostril. It is an important subunit when it comes to nose reconstruction. This article sheds light on the variance in nostril sill disposition among cleft lip patients. A novel marking technique based on differences in sills is presented. Furthermore, the unique anatomical structure of the philtrum-white roll junction is highlighted with a suggested modification to the subunit approximation leading to its reconstitution.

Cleft Lip Repair Comparison Between Inpatient and Outpatient Surgeries: A Multi-Surgeon Experience.

Great variability exists as to whether cleft lip (CL) repair is performed as an inpatient or outpatient surgery. This study's aim is to investigate the authors' institutional experience to see if there is an increase in complications, emergency department (ED) visits, or readmissions to the hospital when performed as outpatient. This study reviewed patients who underwent CL repair between 2012 and 2023 at the authors' institution. Data collected included patient demographics, perioperative details, ED visits and readmissions within thirty days of surgery, and complications. One hundred forty-five patients met inclusion measures. When the surgery was performed as outpatient, there was no significant difference in returning to the ED (p = 0.767) or readmission to the hospital (p = 0.447) within thirty days as compared to inpatient surgeries. Outpatients did not have more postoperative complications (p = 0.698). Bilateral cleft lips were more likely to be performed as inpatient (p = 0.001). Inpatients had a lower weight at time of repair (p = 0.033). Patients with a respiratory (p = .006), gastrointestinal (p = 0.003), or hematologic (p = 0.013) comorbidity had a higher readmission rate. Patients were more likely to be readmitted if they had a younger gestational age (p = 0.005). There was no increased return to the ED or readmission for patients undergoing inpatient versus outpatient CL repair. CL repair can be performed safely in an outpatient setting with careful patient selection.

"Primary anterior septoplasty in a cleft repair improves deviation of the anterior septum but not that of the posterior bone structure."

Evaluation of the result on the nasal septum (NS) of primary anterior septoplasty in cleft surgery is lacking. The deviation in patients with a cleft between those with (S+) and without (S-) primary anterior septoplasty during a cleft lip repair was compared. This was a retrospective, descriptive, single-center study. The NS was evaluated on computed tomography scans obtained pre-operatively from patients who underwent surgery for an alveolar cleft defect. Deviation of the NS was evaluated based on the following parameters: 3D configuration of the NS; anterior, middle, or posterior severity of the NS deviation; location of the most projected point; and severity index. The mean age of evaluation was 6.18 years. A total of 44 (S-) and 48 (S+) patients were included. The NS was less prominent in the (S+) than in (S-) group, 6.25% vs 25%. respectively. In the anterior part, the NS was normal in 79% (S+) and 1% (S-) of the patients. In the posterior region, the prominent deviation rate was approximately 7% in both groups. The greatest deviation point location was identical in both groups. The severity index was higher in the (S-) than in (S+) group, except in the middle part of the NS. Primary anterior septoplasty corrects only the anterior aspect of the NS in most children with CL and CLP. However, the posterior aspect of the NS remains deviated. A posterior deviation is likely to lead to nasal obstruction therefore regular monitoring is required all along the growing period.